Nursing 211

N211: Health Differences Across the Lifespan I of 148 Used for peripheral vasodilation which acts directly on the vessels. These medications are used in extreme hypertension of Pheochromocytoma. Side effects include orthostatic hypotension, weakness and palpitations. Instruct client to watch for signs of drowsiness, lack of energy or weakness. Combines Alpha/Beta Blockers (Normodyne, Coreg) Produce decrease in BP without reflex tachycardia or bradycardia. Side effects are heart failure, ventricular dysrhythmias, blood dyscrasias, bronchospasm and orthostatic hypotension. Alpha Beta blockers are contraindicated in heart failure, heart block and COPD. Calcium Blockers (Procardia, Cardizem, Calan, Isoptin and Sular) Calcium antagonists stop the movement of calcium into the cells, relax smooth muscles causing vasodilation, and inhibit reabsorption of sodium in renal tubules. Calcium antagonists block calcium access to cells by decreasing contractility and decreasing conductivity of the heart. Side effects include headache, hypotension, dizziness, edema, nausea, abdominal discomfort, constipation, peripheral edema and a dry cough. Instruct client to avoid grapefruit juice because it increases serum levels, causing hypotension; avoid high fat meals due to elevation of serum levels. Beta-Adrenergic Blockers (Inderal, Lopressor, Corgard, Blocadren, Tenormin, Zebeta, Toprol) Beta-adrenergic blockers slow the heart rate, reducing cardiac output, decrease the force of the contraction, and decrease the rate of A-V conduction and decreasing renin release from the kidneys. Side effects include bradycardia, insomnia, fatigue, bizarre dreams, sexual dysfunction, decreased HDL, GI disturbance, CHF, decreased blood pressure and depression. Instruct client that these medications may mask symptoms of hypoglycemia, to watch for shortness of breath, check apical pulse daily and to not discontinue abruptly. ACE Inhibitors (Capoten, Vasotec, Zestril, Altace, Lotensin, Accupril) Alpha-receptor blockers dilate peripheral vessels and lower peripheral resistance. They block the enzyme that converts angiotensin I to the potent vasoconstrictor angiotensin II, raises the level of bradykinin (a vasodilator) and lowers aldosterone. ACE inhibitors decrease peripheral vascular resistance without increasing cardiac output, increasing cardiac rate and increasing cardiac contractility. Side effects include proteinuria, neutropenia, skin rash, dizziness, orthostatic hypotension, GI distress, headache and cough. Central Alpha Agonists (Catapress, Wytensin, and Aldomet) Diminish sympathetic outflow from the brain, thereby lowering peripheral resistance. Administer the first dose at bedtime and monitor for first dose syncope which occurs 30-90 minutes after administration. Monitor BP and pulse, as syncope may be preceded by tachycardia. Side effects include dry mouth, fatigue, sexual dysfunction, and drowsiness. Instruct client to make position changes slowly and avoid standing still and taking hot baths and showers. ©2012 Achieve Page 8